陈夏欢,刘梅林,黄波,冯雪茹,梁文奕,张婧薇

• 1:北京大学第一医院老年内科

摘要(Abstract)：

目的观察老年冠心病患者经皮冠状动脉介入治疗(PCI)术后服用替格瑞洛90 mg、每日2次或45 mg、每日2次对腺苷二磷酸(ADP)诱发的血小板聚集率(ADP-Ag)。方法入选2013年12月至2015年12月于北京大学第一医院行PCI治疗的老年冠心病患者48例,年龄(72.48±8.05)岁,比较替格瑞洛90 mg、每日2次(替格瑞洛90 mg组,26例)和替格瑞洛45 mg、每日2次(替格瑞洛45 mg组,22例)。随访12个月,观察主要不良心血管事件和出血事件情况。并对既往服用氯吡格雷75 mg、每日1次更换为替格瑞洛后的ADP-Ag进行比较。结果所有患者服用替格瑞洛治疗4.3(3~7)d后均在清晨空腹服药前抽血检测ADP-Ag谷值,替格瑞洛90 mg组ADP-Ag平均为(27.88±7.77)%,替格瑞洛45 mg组为(37.87±2.90)%,两组比较差异有统计学意义(P=0.039)。替格瑞洛90 mg组12例检测服用替格瑞洛2 h后的ADP-Ag峰值,平均为(19.02±9.52)%;替格瑞洛45 mg组有7例检测了服用替格瑞洛2 h后的ADP-Ag峰值,平均为(27.74±5.09)%,两组比较差异有统计学意义(P=0.041)。21例患者氯吡格雷75 mg、每日1次转换为替格瑞洛90 mg、每日2次时,转化前后ADP-Ag比较差异有统计学意义[(51.70±5.24)%比(26.87±7.33)%,P=0.027]。15例患者氯吡格雷75 mg、每日1次转换为替格瑞洛45 mg、每日2次时,转化前后ADP-Ag比较差异有统计学意义[(47.98±5.39)%比(38.29±2.65)%,P=0.034]。既往氯吡格雷75 mg、每日1次ADP-Ag[(51.18±5.55)%比(64.41±3.03)%,P=0.045],替格瑞洛45 mg、每日2次[(37.87±2.90)%比(64.41±3.03)%,P=0.028],替格瑞洛90mg、每日2次[(27.88±7.77)%比(64.41±3.03)%,P=0.023]均显著低于既往未服用P2Y12受体抑制剂时,差异均有统计学意义。替格瑞洛45mg、每日2次ADP-Ag[(37.87±2.90)%比(51.18±5.55)%,P=0.035],替格瑞洛90 mg、每日2次[(27.88±7.77)%比(51.18±5.55)%,P=0.030]显著低于既往氯吡格雷75 mg、每日1次时,差异有统计学意义。替格瑞洛45 mg、每日2次ADP-Ag与替格瑞洛90mg、每日2次比较[(37.87±2.90)%比(27.88±7.77)%,P=0.039],差异有统计学意义。结论替格瑞洛90 mg、每日2次和45 mg、每日2次对血小板聚集的抑制作用优于氯吡格雷75 mg、每日1次;老年冠心病患者PCI术后使用替格瑞洛45 mg、每日2次安全有效,出血风险降低,心血管事件发生率未增加。

关键词(KeyWords)： 老年;经皮冠状动脉介入治疗;替格瑞洛;血小板聚集;心血管;出血

Abstract:

Keywords:

基金项目(Foundation): 国家重点研发计划项目(2016YFC1301300)

作者(Author): 陈夏欢,刘梅林,黄波,冯雪茹,梁文奕,张婧薇

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